Provider Demographics
NPI:1639405111
Name:THOMPSON EYE CARE
Entity Type:Organization
Organization Name:THOMPSON EYE CARE
Other - Org Name:PEARLE VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-349-2050
Mailing Address - Street 1:1982 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1736
Mailing Address - Country:US
Mailing Address - Phone:517-349-2050
Mailing Address - Fax:517-349-7209
Practice Address - Street 1:1982 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1736
Practice Address - Country:US
Practice Address - Phone:517-349-2050
Practice Address - Fax:517-349-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003790261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901003790OtherSTETE LICENSE NUMBER